﻿<!DOCTYPE html>
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<title>User Credentials</title>
</head>
<body>
    <form action="get" method="post">
        <table style="border:1px solid black;border-collapse:collapse;height:500px">
             <tr>
                <td style="text-align:right;border:1px solid black">
                    <label for="LastName"><strong>Last Name</strong></label>
                </td>
                <td style="border:1px solid black">
                    <input type="text" name="LastName" value="Nakov" id="LastName" style="width:260px" />
                </td>
             </tr>
             <tr>
                <td style="text-align:right;border:1px solid black">
                    <label for="FirstName"><strong>First Name</strong></label>
                </td>
                <td style="border:1px solid black">
                    <input type="text" name="FirstName" value="Svetlin" id="FirstName" style="width:260px" />
                </td>
             </tr>
             <tr>
                <td style="text-align:right;border:1px solid black">
                    <label for="Address"><strong>Address</strong></label>
                </td>
                <td style="border:1px solid black">
                    <textarea name="Address" id="Address" style="width:250px">17 Hristo Botev Str.&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp floor 3 apt. 12</textarea>                                        
                </td>
             </tr>
             <tr>
                <td style="text-align:right;border:1px solid black">
                    <label for="City"><strong>City</strong></label>
                </td>
                <td style="border:1px solid black">
                    <input type="text" name="City" value="Kaspichan"/ id="City" style="width:190px">
                    <label for="State"><strong>State</strong></label>
                    <input type="text" name="State" value=""/ id="State" style="width:40px">                                             
                </td>
             </tr>
             <tr>
                <td style="text-align:right;border:1px solid black">
                    <label for="Zip/Postal Code"><strong>Zip/Postal Code</strong></label>
                </td>
                 <td style="border:1px solid black">
                    <input type="text" name="Zip/Postal Code" value="9325" id="Zip/Postal Code" style="width:60px"/>
                </td>
             </tr>
             <tr>
                <td style="text-align:right;border:1px solid black">
                    <label for="Country"><strong>Country</strong></label>
                </td>
                <td style="border:1px solid black">
                    <select name="Country" id="Country" style="width:190px"><option value="BG">Bulgaria</option></select>                        
                </td>
             </tr>
             <tr>
                <td style="text-align:right;border:1px solid black">
                    <label for="Phone"><strong>Phone(country code<br />area code, number)</strong></label>
                </td>
                <td style="border:1px solid black">
                    (+<input type="text" name="Phone" value="359" id="Phone"/ style="width:50px"> )
                    <input type="text" name="Phone" value="88"/ style="width:50px">
                    - <input type="text" name="Phone" value="8334343"/ style="width:130px">
                </td>
             </tr>
             <tr>
                <td style="text-align:right;border:1px solid black">
                    <label for="Email"><strong>E-mail</strong></label>
                </td>
                <td style="border:1px solid black">
                    <input type="text" name="Email"value="nakov@kaspichan.org" id="Email" style="width:260px" pattern=""/>                        
                </td>
             </tr>
             <tr>
                <td style="text-align:right;border:1px solid black">
                    <label for="Month"><strong>Birth Date</strong></label>
                </td>
                <td style="border:1px solid black">
                    <label for="Month">Month</label>
                    <input type="text" name="Month" value="06" id="Month" style="width:20px"/>
                    <label for="Day">Day</label>
                    <input type="text" name="Day" value="14" id="Day" style="width:20px"/>
                    <label for="Year">Year(4 digits)</label>
                    <input type="text" name="Year" value="1980" id="Year" style="width:50px" />
                </td>
             </tr>
             <tr>
                <td style="text-align:right;border:1px solid black">
                    <label for="Gender"><strong>Gender</strong></label>
                </td>
                <td style="border:1px solid black">
                    <select name="Gender" id="Gender" style="width:80px"><option value="Gender">Male</option></select>                        
                </td>
             </tr>
            <tr>
                <td style="text-align:right;border:1px solid black">
                    <label for="Spring"><strong>Starting Date</strong></label>
                </td>
                <td style="border:1px solid black">
                    <input type="radio" name="Starting Date"value="Spring 2006" checked="checked" id="Spring"" />
                    <label for="Spring" style="font-size:large">Spring 2006</label>
                    <input type="radio" name="Starting Date"value="" id="Summer" /> 
                    <label for="Summer" style="font-size:large" >Summer 2006</label>   
                </td>
            </tr>
            <tr>
                <td style="text-align:right;border:1px solid black">
                    <label for="Comments"><strong>Comments/Questions</strong></label>
                </td>
                <td style="border:1px solid black">
                    <textarea name="Comments" id="Comments" style="width:250px">Please send me more information about the lodging.</textarea>                       
                </td>
            </tr>
            <tr>
                <td colspan="2" style="text-align:center; background-color:lightblue;border:1px solid black">
                    <input type="submit" name="Submit" value="Submit"/>
                    <input type="reset" name="Reset" value="Clear This Form"  />
                </td>
            </tr>
			<tr>
			<td style="background-color:gray;text-align:left;border:1px solid black" colspan="2">
			Done
			</td>
			</tr>
        </table>
    </form>
</body>
</html>
